Provider Demographics
NPI:1205008943
Name:MARK MORRIS DMD PC
Entity Type:Organization
Organization Name:MARK MORRIS DMD PC
Other - Org Name:DENTAL SALON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILKES
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-642-3370
Mailing Address - Street 1:939 W NORTH AVENUE
Mailing Address - Street 2:STE 800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:312-642-3370
Mailing Address - Fax:312-642-6311
Practice Address - Street 1:939 W NORTH AVENUE
Practice Address - Street 2:STE 800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-642-3370
Practice Address - Fax:312-642-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty